Introduction from the History of Medicine Division, National Library of Medicine

This text was originally published in the Philadelphia Journal of the Medical and Physical Sciences in August 1825. It describes the Friends Asylum, which was the first private psychiatric hospital. The Friends Asylum was founded by the Society of Friends and was based on the philosophy of “moral treatment” and Quaker values. The Friends Asylum was renamed Friends Hospital in 1914. Friends Hospital is still in existence and continues to specialize in the treatment of mental and emotional illness.

For more information on this text, please refer to this text’s [Historical Note].

An Account of the Asylum for the Insane, &c

MADNESS, in all its complicated forms, is one of the most afflicting dispensations that can befal [befall] human nature. To mitigate the miseries of so deplorable a malady, and co‐operate in the restoration of those who were lost to civil and religious society, was impressed as a duty on the minds of many members of the Society of Friends, more particularly as it regarded those who professed the tenets of their church. It was believed that a mild and appropriate system of treatment, in which, during lucid intervals, or a state of convalescence, the patient might enjoy the society of those who were of similar habits and opinions, would be productive of peculiar advantages. They justly thought, that the indiscriminate mixture of persons of opposite religious sentiments and practices; of the profligate and the virtuous; the profane and the serious; would very probably check the progress of returning reason.

In pursuance of this laudable object, proposals were, in the year 1811, made to the Yearly Meeting of Philadelphia, from two of the Quarterly Meetings, to make provision for such of their members as were deprived of their reason. The consideration of the subject was referred to a committee, who submitted their report in the following year, which was adopted by the meeting; and, in consequence of this conclusion, a plan and proposals for an asylum were circulated among Friends. This plan was not restricted to the admission of members only, but included all those who professed the principles of the society, under whose care and notice it was to be wholly conducted.

On the 14th of April, 1813, the first meeting of the contributors was held in Philadelphia; and at the succeeding meeting, in June, a Constitution was adopted. The association was designated by the name and title of “The Contributors to the Asylum for the Relief of persons deprived of the use of their Reason." This institution was intended, not only to provide for the suitable accommodation of that afflicted portion of the society who were insane, but to furnish, besides the requisite medical aid, such tender sympathetic attention, and religious oversight, as might soothe their agitated minds, and facilitate their restoration to sanity.

It was a paramount object to establish the site of the proposed institution in a retired situation, which, with the intervention of prohibitory rules, might protect the patients from the gaze of idle curiosity, and the conversation of unfeeling inquirers; and afford a privacy calculated to inspire their troubled minds, on every dawn of intellect, and in every moment of calmness, with consoling evidence, that they were indeed regarded as men and brethren. A tract of land, containing fifty‐two acres, of good quality, in a high and healthy situation, with a large proportion of wood, and well supplied with water, was accordingly purchased: it is situate about five miles from Philadelphia, and one mile westward of Frankford.

At length, under the superintendence of a committee, appointed for that purpose, a large and beautiful stone building was erected, fronting, and at some distance from, the public road. The centre building is sixty feet square, and three stories high, having two wings, each one hundred feet long, and twenty‐four wide; the whole being roofed with slate. The wings are two stories in height, each containing twenty chambers for patients, about ten feet square, with a gallery or passage ten feet wide. In the basement of the centre building, are the refectory, kitchen, ironing‐room, store‐room, and pantry, with rooms adjoining, under the wings, for cooking, washing, &c. The remainder of the basement of the wings is divided by arches, serving as repositories for fuel, store‐rooms, smoke‐house, &c. The first story of the centre building has four large rooms, two of which are appropriated as day‐rooms for the patients, and the others, one for the accommodation of the superintendent and his family, and the other as an office for the Visiting Managers to meet in, also for a library, and a case containing the necessary medicines. The second story consists of two large rooms, also employed as day‐rooms, for the least noisy and convalescent patients, and of four smaller ones, used for the accommodation of the superintendent's family. There are four large and three small rooms in the third story, for the reception of patients; and four comfortable lodging rooms, with two windows to each, in the garret, besides five large and convenient closets.

In the arrangements of the building, economy, and convenience have been studied with equal success. The great extension of the front to the length of two hundred and sixty feet, arose from the desire of affording every comfort to the patients, derivable from that important auxiliary in convalescence, the free admission of light and air. Their influence on organic and inorganic bodies, requires no elucidation. The free circulation of air, the great supporter of life, is of primary importance; – without proper ventilation, the resources of medicine may be developed in vain; the miserable sufferers are suffocated in the effluvia of their own bodies, and a long train of physical evils are added to their mental miseries. In the construction of receptacles for lunatics, rooms are, in general, placed on both sides of the galleries, into which a gloomy light, and a small supply of air, are admitted by doors and windows at their extremities. The plan adopted at the Friends' Asylum, in this respect, is worthy of imitation. On one aide of the long galleries are situated the chambers; on the other a corresponding number of windows: over each door, there is a stationary cast‐iron sash, fixed in an oblong ventilator, thirty‐two by twenty inches, over which is a corresponding moveable sash, of wood, containing ten panes of glass. Small doors, about seven inches square, are fixed in the pannel [panel] of every door, secured as well as the latter, by mortise locks, so constructed, that they cannot be opened from within: these serve for the purpose of conveying food, &c. to violent patients, and of frequently examining their situation, without the trouble and disturbance of entering their chambers. The same contrivance exists in the third story of the centre building. The windows of the galleries, as well as of the seven rooms in the third story, are also provided with stationary cast iron frames. The lower sashes have panes of glass in them, six by eight inches in size; the upper are without glass, outside of which are wooden frames corresponding in size, which are glazed, and hung so as to be raised of lowered at pleasure: this admirable plan unites the advantages of security, neatness, and durability, and removes the aspect of a place of confinement, which iron bars would necessarily occasion. There is a similar window in each chamber, fifty‐four by thirty‐four inches in dimension, communicating directly with the external air. Thus a free current of air may not only be made to circulate in the very recesses of the Asylum, but, when necessary, its admission may be regulated by circumstances.

The same may be said with regard to the admission of light, the impressions of which it is necessary to modify according to the excitability and health of the patient. By means of outside shutters, the restless, sleepless, and unmanageable individual may be placed in salutary darkness; whilst the fearful patient, with irritable senses, all whose symptoms are aggravated by it, may enjoy the full light, while he breathes the fresh air, of heaven. Experience has proved, had not the scale of the building comprised, in its extensive wings, single ranges of chambers for patients, with the accommodation of ample and airy galleries, together with the advantages derived from the commodious day rooms of the centre building, that adequate comfort could not have been afforded to the afflicted inhabitants, and that the progress of recovery would have been considerably retarded, if not arrested; – more particularly during those seasons of the year when the patients are necessarily confined to the house.

There is an indescribable horror attached to the idea of a conflagration in a Lunatic Asylum, which causes the most insensible to shudder. The criminal within the walls of his prison, when he hears the appalling cry of fire, and the grating of the door which releases him from its fury, is alive to his danger, and rushes forth to life and liberty. The unhappy mariner, in the midst of the ocean, when he sees the flames twining around his bark, retires conscious of his peril, to his frail and feeble boat, and clinging to life with all the pertinacity inspired by nature and reason, watches the approach of some heaven‐directed sail, to rescue him from destruction. Not so the miserable maniac: insensible to his danger, and obstinately refusing to quit his apartment, even when time is allowed to afford him free egress, he can only be rescued from an awful death by force, which the progress of the flames often renders it difficult, and sometimes impossible to employ¹. – Hence, in the Friends' Asylum, the utmost care is taken to guard against so dreadful a calamity. The bottoms of the floors, and the sides of the joists, from the first story to the garret inclusive, are plastered with two coats of mortar, and then ceiled in the usual way: this renders the building more wholesome and comfortable than if it were arched with brick or stone, and almost, if not altogether, as secure from fire. The whole of the basements of the wings, in which are situated the stoves for warming the chambers, is paved with brick: of the same material are the floors of the wash‐house, scullery, and about one‐third of the kitchen adjoining the fire‐place and oven. A close stove in the dining‐room, is heated during the time of meals, and after the early hour of supper, is suffered to expire, and becomes extinguished before the family retires for the night. The stoves in the day‐rooms are guarded with preventives, which renders it impossible for the patients to have access to the fire they contain; transverse pieces of iron secure the apertures intended for the admission of air, and the larger doors can only be opened by instruments in the possession of the keepers. To all these precautions is added the careful inspection of the superintendent, after the other members of the family have retired to rest.

A majority of the insane require warmth, although there are many who can bear cold with great impunity, and others are insensible to, although they suffer by it. Hence a safe, certain, and effectual mode of warming the interior of the wings, has been adopted, by means of large stoves, or ovens, fixed in the arches of the basement of each wing, the heated air from which is conducted by flues into the galleries, and issues at two separate apertures in each, well secured with marble. Separate from this general plan, there is also a warming apparatus, on the same principle, under several of the rooms in each wing, which conducts the warm air directly into the chambers.

At the north‐western extremity of the passage in the basement, is an ice‐house, for preserving provisions during the summer season, filled from without, but having a communication with the interior. A full supply of water from a never‐failing spring, is obtained by means of a forcing pump, placed in a stone building, two stories in height, and situated at a short distance from the main house: in this building are the seed‐room, and a work‐shop for the patients, provided with all the necessary tools. The water is introduced through leaden pipes, into a large reservoir in the garret of the south‐east wing, whence it is conveyed to the kitchen and scullery, and to the warm, cold, and shower baths, fitted up, for the benefit of the patients, in the second story of the same wing. At each extremity of the wings are enclosed passages and stairs, eight feet broad, leading to the yards. A neat vestibule, in the rear, surrounded with seats, and sixteen feet in length, hangs over the area, and leads to the flower garden. It is completely enclosed with Venetian shutters, and affords a cool and delightful retreat, where the summer's sun cannot penetrate, and a constant current of air flows refreshingly through the spacious hall which leads into the interior of the building. In the rear, or south‐west side, of the centre building, there is an area, fifteen feet wide, connected with one of ten feet in width along the north‐western wing, and paved with brick. These areas are surrounded with a luxuriant grass bank, rising regularly to a level with the vestibule, and surmounted with a beautiful range of low junipers. In the rear of the wings are situated the yards or airing grounds, for the use of the male and female patients, separated by the space in the rear of the centre building, and each containing about five‐ninths of an acre of ground, in grass, surrounded by walks. These are enclosed by board fences, ten feet in height, on the top of which is a simple, but effectual apparatus for preventing the escape of the patients. Boards about eight feet long and eight inches broad, and apparently forming part of the stationary fence, but detached from it, are placed around the whole circuit of the enclosure: these are connected to the fence beneath by hinges. Blocks of wood, about two feet long, are attached to these boards on the outside, at the lower part of which, are rings through which a strong wire is conducted: at the extremities of these wires alarum bells are attached. When the patient, in attempting to escape, seizes one of these moveable boards, it turns inwards on its hinges, the adventurer falls back into the yard, and the appendant blocks of wood, protruding, stretch the wire, and sound the alarm, which is distinctly heard through the building. Sheds, surrounded with seats, are about to be erected in each yard, for the accommodation of the patients.

The flower garden, extending from the vestibule to a dark green hedge of cedar, which separates it from the kitchen garden, offers a rich repast to the eye. Thickly blooming double‐blossomed almonds – splendid groups of variegated tulips – rich blue flags – dark sweet‐scented shrub—violets—bowers of honey‐suckle—clustering roses—pure white lilies—and a great variety of beautiful shrubs and flowers, mingle their rich and various tints, and shed around a delicious fragrance in this miniature conservatory of the beauties of nature.

The kitchen garden comprises about one and an half acres of ground, and, under the care of a skilful horticulturist, affords abundance of vegetables for the use of the patients. From this source alone, they are plentifully supplied, at the proper seasons, with a great variety of wholesome vegetables. Cauliflowers, and early vegetables of various kinds, are successfully reared in hot‐beds; and a sufficient quantity of tobacco for the restricted consumption of the convalescent patients, is also grown on the premises. Salutary herbs, and medicinal plants, so essential to the invalid, are cultivated in large quantities. The nursery contains peaches, apricots, and a number of thriving young trees and shrubs. The garden affords, besides, a sufficient supply of raspberries and currants for the whole family; a few peaches, goose‐berries, strawberries, and muskmelons. Plums, cherries, apples and pears, are to be found throughout the grounds.

About thirty acres of the farm are in a state of cultivation; the rest is woodland. It is separated from the road which passes in front of it, by a flourishing thorn hedge. Crops of grass are principally grown, with a sufficient quantity of corn and potatoes for the consumption of the family, and some wheat. Six milch cows supply the table with a large quantity of milk and butter, although not equal to the consumption throughout the year. The barn is spacious and built of stone, and a substantial wall of the same material, encloses the barn‐yard.

A shaded, serpentine walk, now skirting the edge of the wood, now plunging into its dark and dependent foliage, and embracing, in its windings, more than a mile, leads over a neat and lightly constructed bridge, to a pleasure house, which might justly be termed the Temple of Solitude. It is securely founded on a rock, which juts abruptly forth from the declivity of a steep hill, three sides of which are almost perpendicular, and of considerable height. A chasm, formed by nature, in the rock, to the left of the entrance, affords, with the assistance of stones transversely arranged, a descent to the small valley beneath. The straight and towering tulip‐tree, the sturdy oak, the chesnut [chestnut], and the beech, cast their cool shadows around this wood‐embosomed abode of contemplation. A rapid stream ripples over the rocks, at a few yards distance, producing the melancholy, but pleasing, sounds of a distant waterfall. On the left, in the distance, the eye encounters a rude, and magnificent wilderness, where the cedar mingles its deep evergreen with the rocks, piled in huge masses, one upon another: on the right appears a dark and almost impenetrable thicket, skirting and overshadowing the rivulet. The light and airy fabric, perched on the brow of the rock, could alone betray to the enchanted visiter, that this sweet, lonely, and romantic retreat, had ever before been explored by man. Bacon remarks, that whosoever is delighted with solitude, is either a wild beast, or a god; and Cicero says, that nature abhors it: but

    “Are not these woods
    “More free from peril than the envious court?”

And cannot the rational man

     “Exempt from public haunt,
    “Find tongues in trees, books in the running brooks”
    “Sermons in stones, and good in every thing?”

The treatment of insanity may be divided into two kinds; moral and medical; at the present day, the great majority of medical men expect happier effects from the former than the latter.² With the exception of pharmaceutic preparations and medicines, every thing belongs to the moral treatment; – for example, the habitation, classification, cleanliness, diet, coercion, punishment, treatment of the feelings, treatment of the intellectual faculties, and occupation of the patients. Of these, as connected with the Friends' Asylum, it is necessary to speak. It is neither our province, nor have we the capacity, to offer any remarks, except in general terms, on the medical treatment which is adopted. Insanity and its symptoms present as much variety with regard to causes and circumstances, as any other disease. There is not, and there never can be, a specific remedy against it. Many think with Pinel, that medical treatment is of no use in that disease; " but it is only," says Dr. Rush, " because the diseases of the moral faculty have not been traced to a connexion with physical causes, that medical writers have neglected to give them a place in their systems of nosology, and that so few attempts have been hitherto made to lessen or remove them by physical, as well as rational and moral remedies.” It is true, that when insanity is treated as a corporeal disease with too little discrimination – when all the treatment appears, as if there were a remedy against every symptom – when every thing is one unvaried routine of hospital practice – many ill effects will ensue, because the varieties of insanity cannot, or ought not to be treated by any general rule. There is no doubt that nature often cures insanity, but she at least as often causes the patient to become fatuous. As the patient in other diseases, is often relieved by art, and would die without it, so is it with insanity. Nevertheless, that physician acts well who, with proper discrimination, “Gives melancholy up to nature's care, and sends the patient into purer air." We agree with Spurzheim, that the medical treatment of insanity ought to be governed by the general principles of pathology; – that the brain, being an organic structure, requires, as to anatomy, physiology, and pathology, every consideration yielded to any other organ; – that it is generated and nourished, increases and decreases, falls sick and is cured, like the rest of the body; – that the material changes of the instruments alone, are the cause that the manifestations of the mind are deranged; – that, in the cure of insanity, the instruments alone are restored to their natural state; – and, that the mind, as immaterial, cannot undergo any physical change. Upon the general principle that the proximate cause of insanity is corporeal, and resides in the brain, the practice in the Asylum appears to be rationally founded. An experienced physician, residing within a mile, visits the institution daily, and performs the functions of his office with care, discrimination, ability, and humanity; – qualities, eminently essential in a professional man, and which have not a little contributed, in the present case, to the happy results which have attended the general efforts to “unknit the sorrow‐wreathen knots" on the brow of the maniac, and restore him to the dignity of his nature. The establishment, moreover, enjoys the advantage of possessing, in the person of the superintendent, a resident physician of long experience, and ready to administer the proper remedies in cases which require immediate relief. What a source of self‐gratulation and honest pride must it be to all those whose benevolent exertions are more immediately directed to meliorating the conditions of the unhappy patients, to contemplate them as

    “The charm dissolves apace,
    “And as the morning steals upon the night,
    “Melting the darkness, so their rising senses
    “Begin to chase the ignorant fumes that mantle
    “Their clearer reason.”

But although the use of drugs and medicaments is allowed, in almost every case, to be indispensable, less weight is attached to it in the Friends' Asylum, than to moral treatment. A full conviction of a the propriety of mild, but regular treatment, of attention to the dispositions and wants of the patients, of providing suitable employment and recreations, and, above all, of cherishing every ray of returning reason, is the settled principle of action at the Asylum. The great variety of character necessarily embraced in the cases introduced to the care of the institution, frequently renders it extremely troublesome and difficult to “fetter strong madness with a silken thread." To demonstrate the great labour required to effect this all‐important object, and the different means it is necessary judiciously to apply, we need only designate a few of the prominent and manifold symptoms which attend this frightful disorder. A leading feature is a rapid, raving delirium, in which the conceptions of thought appear too rapid and changeable for a distinct utterance of the corresponding words, which have little or no connexion with each other: sometimes, half sentences are given, time not being afforded for perfect ones, before the thought is changed. Patients of this description will often laugh, and cry, and pray, and swear, almost at the same moment; while others will rave for days and weeks together upon one subject. Another feature is a total perversion of the affections, and of all common opinions: the nearest relations and best friends are become with them their worst enemies; their food is poisoned, and the world is ruined: and their very senses bring them wrong information: they are tormented with the most gloomy and groundless suspicions, and labour under the most abject fears and terrific apprehensions. Others fancy themselves afflicted with tormenting and incurable diseases: others contend that they have committed the most unpardonable sins. Some fancy themselves transformed into the prince of darkness, or into obnoxious animals, which it would be proper to destroy: some seem constantly bent on self‐destruction; while others fancy that they are to suffer under the most unjust sentences, and constantly plead their innocence. Others mourn over their afflictions, and ask every one that approaches them, whether it is possible for them ever to recover from their horrid state. Some vociferate from morning till night, and make all the noise possible; others laugh, and dance, and sing continually. Some fancy themselves kings, queens, generals, or other great characters; and many usurp the dignity of heavenly beings, and utter that which, in others, would be blasphemy. Some have an unconquerable propensity to steal; others play with or conceal old rusty nails, remnants of cloth, or ends of thread or tape, as treasures of great value, with which they decorate their persons. Some seize every opportunity in their power, to tear to small pieces, their clothes and bed covering, to break the windows and furniture, and abuse all around them; others will make use of improper language or conduct – yet at the same time, will talk rationally, and if asked their reason for so doing, will say that they were compelled to do it, by something impressed upon their thoughts. Some are vindictively furious; some insist upon it that they are bewitched; and some that they are haunted by demons or wild beasts: and the most troublesome symptom of all is, where the hallucinations approach so near to rationality, as to be with difficulty distinguished from it, their friends have used them ill, and they are worse treated than others of the family. Some discover an irresistible propensity to drunkenness, or to making the most foolish bargains, and have a total disregard of necessary economy; while others suffer under the most deplorable mental depression, and will sit for hours, and days, and weeks, and months, nay years, under the influence of settled melancholy. Some fear poverty in the midst of plenty; others complain of, and continue in, the most obstinate apathy. Some are afflicted with nervous or mental stupor, (following over‐excitement, and arising from collapse of the vessels of the brain,) in which both the animal and mental functions seem locked up, the eyes appear fixed, the tongue bound, and the senses, as well as the limbs, refuse to perform their respective offices.³ In fine, “one sees more devils than vast hell can hold;'' – another is "a. merry, mad‐cap‐lord;” – and a third is as “mad as the sea and wind, when both contend which is the mightier:” one is possessed of visions which "make him gasp, and stare, and catch the air;"while another, in that pitiable state which ought to command all our commisseration [commiseration], is ready to exclaim “I am not mad; – I would to heaven I were, for then it's like I should forget myself." – All these varied species may, at this moment, be found within the walls of the Asylum; and hence the difficulty of adapting to each the proper mode of treatment. Towards every description of cases, however, whether the disease be of long, or more recent duration, or whether the symptoms are mild or severe, the most soothing and gentle treatment is uniformly extended. The superintendent and matron, with the visiting physician and assistants, are thus enabled, in general, to obtain the confidence, and to produce a degree of discipline amongst the subjects of their care, the accomplishment of which, by such means, is considered an object of primary importance. Having acquired this desirable control, an opportunity is afforded for minute investigation of the peculiar character of each case, showing the medical remedies necessary to be employed, as well as pointing out those essential moral auxiliaries, which sympathetic feeling and an attentive observation of mental disorders, are calculated to suggest. Steadily pursuing these modes of management, those concerned in the application, are, in general, not long without satisfactory evidence of their efficacy; and their benefits cannot be better substantiated than in the cure of a great number, and the melioration of All, of the patients, who have been admitted into the Asylum.

With regard to the Habitation of the patients, in the present case, we have already shown it to be possessed of every comfort which a high and healthy situation, free ventilation, and ample space, can afford. Here the spacious windows open upon green fields and agreeable scenery, not upon gloomy walls and melancholy objects. Here we see no patients fastened by chains, and sitting at the grating of their doors or windows like savage animals in cages; or grovelling in dark, cold, and filthy cells. We see here no miserable beings, lying upon straw and dirt, exposed to all vicissitudes of season and weather, reduced to the mercy of a turnkey, and less attended to than a horse or a wild beast. In fine, the Friends' Asylum is not suited to produce insanity, or to prevent, rather than promote restoration to health: it is not intended as a place of imprisonment, but a place of cure. We find there no beautiful architecture, no fine columns, superb stair cases, lofty domes, and external decorations, but what appear much more essential, neatness, comfort and convenience.

A most important part of the moral treatment of patients, is the proper Classification of them. It is obviously disadvantageous to mingle the furious and the melancholy, the imperious and the fearful, the vociferous and the peaceful, the villainous and religious, the clean and unclean, the curable, convalescent, and incurable together. These divisions ought properly, and according to Spurzheim's plan, to be three in number; – the curable, the incurable, and the convalescent. But the form of the building at the Asylum will not admit of this; nor, taking into consideration the number of patients, is it now a matter of particular importance. That a building erected at some distance from the present fabric, for the purpose of separating the violent and noisy patients, from those who, in a convalescent or more quiet state, are annoyed, and injured by the sound, would be of great advantage, is indisputable: but according to the existing arrangement, this evil is avoided as much as it can be, until the funds of the institution will admit of further improvement, by providing a separate receptacle for the violent and incurable. The patients are divided into two classes: the upper stories of the wings are appropriated to the harmless, the quiet, and the convalescent; the lower stories, to the violent, the noisy, and incurable. Each class, both in the male and female department, has a distinct day‐room, twenty‐two by twenty feet in dimension. When a patient, which seldom happens, is incessantly vociferous, he is removed to an apartment in the fourth story of the centre building, where his cries are less distinctly heard.

The personal comforts of the patients, in a curative point of view, are of great importance; among these cleanliness holds a conspicuous rank, because it is absolutely necessary to health. In the Friends' Asylum, there is no suffocating effluvium, to excite nausea and vomiting. The frequent, and in some cases daily use of baths, a strict attention to the apparel and persons of the patients, and the care which is taken to cleanse and purify the beds, chambers, and galleries, give to the sufferers every advantage, both as to health and bodily comfort, that cleanliness can impart.

The diet of the patients is of course regulated by their peculiar symptoms. Those who can be entrusted with the management of their own appetite, being about two‐thirds of the whole number, assemble at meal‐time in the refectory, and eat together. It is then only that the male and female patients meet, and are seated on different sides of the tables. Their food is of the most wholesome and substantial kind, and such as may be found on the tables of the middle class of society, and of respectable boarding houses. The board of the farmer, though wealthy, does not equal it. There are no meagre‐days, – no days set apart for meat; nor is there fixed food on fixed days of the week. Breakfast is served in summer about six, in winter between seven and eight o'clock; it consists of coffee, superfine wheat bread and butter, fish or meat, and potatoes; or, for those who prefer them, boiled milk and bread. The dinner bell sounds throughout the year at meridian. Fresh beef, veal, mutton, or pork, with a great variety of vegetables, according to the season, and occasionally salt meat, followed daily by pies or puddings, constitute this repast. It is seldom, as it is the case in the Friends' Asylum, that we see on the tables of similar institutions, the most choice pieces of meat, and such vegetables as asparagus, cauliflowers, green‐peas, tomatoes, egg‐plants, &c.: yet even these are as common here as on the tables of the rich. Supper takes place in summer at seven, in winter at five o'clock; and consists of tea, bread and milk, sometimes chocolate, wheat bread, and pickles, varied occasionally with mush, and cakes of different kinds. No spirituous, or fermented liquors are allowed. Soon after dark all the patients are secured in their respective chambers excepting those convalescents who enjoy the liberty of the grounds, and who remain with the family until their usual hour of retiring to rest, which is nine o'clock. The superintendent and his family, and during a part of the year, the managers who weekly inspect the institution, eat at the same table. There is no distinct table for any part of the family whatever. This course is highly gratifying to the feelings of the patients: they find themselves, in a degree, placed upon an equality, with those who are labouring for their restoration, and who, if rarely seen, and then only in the character of superiors, they would fear, but not love. Their almost uniform exemplary and quiet conduct during meals, is the best pledge of the respect and affection which violent means can never impress on the maniac, and which kindness, sympathy, and benevolence, only can excite.

Those who eat in their respective day‐rooms, are prevented from attending the common table from different causes. Some are too voracious; while it is necessary to compel others to take nourishment. As the diet is made conformable to the particular curative plan adopted towards each individual, it is of course necessary to give him his appointed food, according to the prescription of the visiting physician, and remove from him the power of acting in opposition to it. This class, with two exceptions only, eat together in their day‐rooms.

Coercion forms a material part of the moral treatment of insanity, and no other point has been subject to more disgusting and enormous abuses. Reason and experience show the necessity of confining those who are deprived of the use of their reason, in such a manner as to prevent them from injuring themselves or others; but to chain, and to beat them, is both cruel and absurd. That coercion is only to be considered as “a protecting and salutary restraint," is the principle adopted at the Asylum. It would, indeed, be a very convenient mode for the keeper to iron every one who is a little troublesome; to indulge the vindictive feelings which the inconsistent, but often half‐rational conduct of the patient frequently excites in his mind, by indiscriminate punishment; – and to lessen his labour with “all the apparatus of chains, darkness, and anodynes." In the Friends' Asylum this would be impossible. The selection of attendants is so judiciously made, that none would have the will did they possess the power, to pursue such a course. They are not allowed to apply any extraordinary coercion, by way of punishment, nor to change in any degree, the usual mode of treatment, without the permission of the superintendent. Some patients are perfectly unmanageable without bodily restraint; and the most material point is to discover the different means of coercion which different patients require. As the most tender method generally produces the best effect, the mildest possible means are adopted; all experience having shown the greater efficacy of mildness. Hence no stripes and blows, no resentment, no return of injury, are permitted. A keeper who, under any circumstances, might return a blow from, or strike a patient, would be instantly dismissed. Here are no iron bands or collars – no handcuffs – no manacles – no fetters – nothing to convert the poor patients into felons, and their abode into what Pinel calls a “medical poison." The eye of the patient is not offended by the constant view of iron grates or bars, nor his ear burdened with the rattling and clanking of chains: the construction of the window frames prevents the former, and the substitution of leather for iron, the latter.

Confinement in a solitary chamber, is found, in most instances to prove effectual. In certain violent cases, however, it is necessary to adopt more powerful means. The patient is then secluded in a gloomy, rather than a dark room, and when the extremity of coercion is found to be absolutely necessary, a case which seldom occurs, he is confined in a strait waistcoat, and in a recumbent posture, by means of broad leathern belts crossing his breast and legs, with straps affixed, which encircle his wrists and ankles. During the last year, only a single patient was confined in this manner: this was a recent case, (May, 1825,) and perhaps one of the most violent that has fallen under the care of the institution. It is a fixed rule to employ coercion no more, and no longer, than personal safety requires; for nothing is more certain than that the cure, is retarded by unnecessary confinement. If an individual is furious for a few days, or at particular intervals, he is not, on that account, fettered for years; and the cases are rare indeed, where constant personal confinement is indispensable. At the present time, two patients only are secluded; one an incurable, the other a recent case; and before the admission of the latter, the former was, for more than eighteen months, the only instance of permanent confinement in a chamber. Of those who are permitted the range of the yards, the galleries, and the day‐rooms, one only is confined to a chair, and another, her sister, so secured with foot‐straps of leather, as not to impede her walking, while she is prevented from passing over the fence, a feat, which she would otherwise accomplish with facility. Thus among thirty‐seven patients, one only is permanently secluded, but without other bodily restraint – one only under the first paroxysms of mania, is temporarily confined with unavoidable strictness – one only, is bound in the common sitting‐room, with a leathern belt which admits of almost every change of position – and only one is prevented from escaping, by means of long and easy straps around the ankles.

Punishments, properly adapted and judiciously applied, are indispensable; but corporeal punishment by blows, is not tolerated, on any pretext whatever. When persuasion and mild means fail, resort must be had to that principle of fear, which has a salutary effect upon all society, when moderately and prudently excited by the operation of just and equal laws. Without a temperate, but firm, administration of power, the necessary discipline could not be preserved, and all would become chaos and confusion. But, governed by the irrefragable truth, that

    ————————–“All constraint,
    “Except what wisdom lays on evil man,
    “Is evil,” ——————————
    ——————————“And begets,
    “In those that suffer it, a sordid mind,
    “Bestial, a meager intellect, unfit
    “To be the tenant of man’s noble form,”

it is the constant endeavour of the superintendent and matron, and of the attendants, to excite as much as possible the operation of superior motives, and to induce fear, by means of austerity or punishment, only when a necessary object cannot otherwise be obtained. In such cases, recourse is had to the shower bath, immersion in water, solitary confinement, and, very rarely, to the strait waistcoat, or leathern straps.

No other modes of punishment are known in the Asylum, and it has been experimentally proved, that the power of judicious kindness is much more effectual in preventing misconduct, than personal punishment. Some may maintain that, as an influence must be obtained over the patient through the medium of fear, blows and stripes are the best means of producing a permanent impression, and that corporeal punishment may sometimes render people rational by the impression of terror; others, with great simplicity, abhor the idea of inflicting any punishment, however mild, on the insane, who are incapable of discriminating right from wrong, and therefore “know not what they do." The former opinion is cruel, absurd, antichristian, and brutal. All experience has proved that austerity and rigour, assumed consequence, and airs of self‐importance, are the least effectual means of obtaining an influence over them. As to the latter opinion, punishment is never inflicted on those who have no self‐control over their actions. But the great majority of insane persons possess a degree of command over their wayward propensities, and have the power to distinguish good from evil. In such cases, few will deny, not only the propriety, but necessity, of salutary coercion.

The proper mode of treating the feelings and intellectual faculties of the variously disordered patients, is one among the most difficult duties performed in the institution. The good and ill‐tempered; the bashful and indecent; the morose and the gay; the quarrelsome and friendly; the mischievous and peaceable; the rebellious and obedient; the obstinate and tractable; the cunning and ingenuous; the proud and modest; the open, candid, and mild; the distrustful, jealous, envious, vindictive, irascible, or overbearing; – and, in short, every variety of character requires different treatment, for which it is impossible to lay down general rules.⁴ One must be soothed, and another threatened. Gentle manners, kindness, and the greatest mildness, form the ground‐work of the system, by which the feelings of the patients in the Asylum are generally controlled and interested. Kind, but firm, authority, is used to keep others in subjection. Derision and deception, as extremely hurtful, are never employed. Ridicule, acting on the self‐esteem of the individual, more firmly fixes the erroneous notions which it is intended to eradicate, and the detection of deception, however praise‐worthy the object, is naturally followed by the loss of that confidence and respect which the patients ought to entertain for the persons who treat and govern them. As to the intellectual faculties, no advantage, except in extremely rare cases, has been found to arise from reasoning with them on their peculiar hallucinations; because, one of the distinguishing marks of insanity, is a fixed false conception, which occasions an almost total incapacity of conviction. In fact, the exhibition of logic as a remedy, is attended with little or no success. “An endeavour," says Mr. Haslam, " to convince madmen of their errors by reasoning, is folly in those who attempt it, since there is always, in madness, the firmest conviction of the truth of what is false, and which the clearest and most circumstantial evidence cannot remove." Instead, therefore, of endeavouring to prove, according to logical rules, to a patient, who, even when in health, may have been incapable of, or unaccustomed to close reasoning that his ideas are false, and his sensations deranged, the superintendent treats him as a rational being, and introduces in conversation such topics as he knows will most interest him, and on which he is best qualified to converse. It has been found, that the less notice that is taken of the fancies of the patients, the less disposed will they be to retain them. In the intercourse which the greater part enjoy with the family of the superintendent – in the constant and general inspection of the superintendent and matron – and in the management of the attendants – no practicable means are neglected, which may tend to change the train of thoughts, interest the affections, and remove or diminish the painful sensations of the sufferer. In a word, the Friends' Asylum presents rather the pleasing picture of a large family united in the bonds of love, than of a receptacle for lunatics.

Nothing can more strongly establish the usefulness of Occupation than the fact, that in those asylums for insane, where labour makes a part of the regimen, a greater number of patients recover;⁵ and in the present instance it is fully corroborated; for of one hundred and forty‐one patients admitted into the Friends' Asylum, from the time it was opened in May, 1817, up to the month of March, 1825, only eighteen remained in the house without much sensible improvement. In many cases the disease is nourished from want of suitable occupation and recreation, and the health of the patients is injured by want of bodily exercise. Much attention, therefore, is given to devise means for employing their time, according to their several capacities. The whole business of the farm, under the regulation and with the aid of the farmer, is performed by such patients as from habit and health, are equal to the task. The gardener derives his sole aid in digging, planting, weeding, wheeling, and watering from them. All the wood, (for which economy urges the substitution of coal,⁶) consumed in the establishment, is sawed, split, wheeled, and piled by the patients. All the water used in the house, is thrown into the reservoir by their labour at the forcing pump. A part of the male patients work at the washing‐machines; of the female, at the washing‐tubs. Tools are provided in the work shops for those who can be entrusted with them. The walks, grass‐plots, and grounds immediately around the house, are kept in order by them; and the male patients assist in the house‐work, necessary in their wing. The female patients are from necessity more steadily employed than the male, but with less bodily exercise. During the winter, their occupations are not impeded, while husbandry and horticulture, which, at other seasons, employ the other sex, are stationary. The greater number of the women are regularly engaged, according to circumstances, in washing, ironing, house‐work, chamber‐work, kitchen‐work, needle‐work, knitting, spinning, &c. The important results arising from this system of occupation, are daily apparent. Spurzheim remarks “that, in all institutions for insane, the male patients who assist in cutting wood, making fire, and digging in the garden, and the females who are employed in washing, ironing, and scrubbing floors, often recover; while persons, whose rank exempts them from performing such services, languish away their life within the walls." These remarks do not apply to the Friends' Asylum. It is unjustifiable, and even criminal, to permit any considerations of rank to interfere with the curative process. A monarch, afflicted with insanity, had he the power of choice, would willingly barter his crown, and descend to menial employments, to obtain restoration to reason. Hence, little or no stress is put upon the previous situation of the patient, except as it relates to a due regard to his feelings, and a proper adaptation of labour; and, we are taught by experience, that the greater part, when thus employed, never fail to enjoy a more happy state. At this moment the institution affords the example of a physician, strongly interested in horticulture, and continually employed in different vocations within the gardens; a silversmith and a taylor [tailor], of course accustomed to sedentary occupations, are particularly industrious in cutting wood: a merchant may be seen at the washing machine, and a thrifty farmer scrubbing the floors of the galleries. Females, delicately reared, accustomed at home to little manual labour, may be found, willingly and cheerfully, assisting in the kitchen, or in the chambers. In fine, the idea ought to be universally eradicated, that strong and vigorous patients, on whom moderate manual labour would produce the happiest results, should be suffered to loiter away their time in idleness and apathy, brooding over and increasing their delusive conceptions, merely because they chanced to have been born and educated in a particular rank of society.

Recreation, as well as occupation, is afforded to the patients; and various means are taken to withdraw their minds from injurious and melancholy musings: among these may be enumerated, long walks around the grounds, riding through the country, reading, writing, &c. One‐fourth of the patients, five of whom are considered incurable, are, during the day, under no personal restraint; and have full liberty to employ and amuse themselves within the precincts of the farm; some of these associate altogether with, and are almost considered a part of, the, superintendent's family. Others are daily invited into the parlour or office, where they enter into conversation, or peruse the newspapers. Many of the patients attend Friends' meeting at Frankford, twice in each week. But, speaking in a general point of view, much remains to be effected in this branch of the moral treatment of the insane; and it has been well remarked, that if the same ingenuity were exerted to increase their recreations, as are frequently employed to amuse the vain, the frivolous, and the idle, many more gleams of comfort would be shed over the unhappy existence of lunatics. Many modes of amusement might be beneficially introduced into the present establishment. The courts of the Retreat, near York, in England, are supplied with rabbits, sea‐gulls, hawks, and poultry, which are generally very familiar with the patients; and it is believed that they are not only the means of innocent pleasure, but that the intercourse with them, sometimes tends to awaken the social and benevolent feelings. Music, regulated according to the feelings of the patient, but never analogous to the deranged manifestations of the mind, might be advantageously employed. Various games of ball would accelerate the recovery of the convalescent: the erection of a ball‐alley, which might be so readily accomplished by increasing the height of a small part of the fence, and levelling a corner of the men's yard, would yield both exercise and amusement in the game of hand‐ball. And a more invigorating and suitable sport could not well be imagined, than bowls, or nine‐pins.

The immediate superintendence of the Asylum is conducted on principles which cannot fail of bringing forth good fruit, where the parent stalk is not irretrievably blighted. It is not guided merely by a sense of duty, as the agents of the contributors, but by the conscientious and religious feelings which ought to bind all the children of men together, in bonds of brotherly love. Authority and order is maintained rather by kindness, condescension, and indulgent attention, than by severity; the afflicted are treated as rational beings, not as brutes. The superintendent and matron never sit at table without being surrounded by lunatics; – one or more are constantly in the family parlour; – not an hour in the day are they separated from some among them; – and in return for the kindness shown towards them, and the feeling manner in which they are treated, the patients almost uniformly behave with propriety, and many of them cherish towards their benefactors the warmest gratitude, affection, and respect. A striking proof of the power obtained over the patients, almost exclusively by mild treatment, occurs on every Sabbath evening, when they are all, both male and female, with the exception of the one or two permanently secluded, collected together in their respective day‐rooms, where a portion of the scriptures is read to them. It is seldom that any interruptions take place; on the contrary, the silence and quiet that reigns around are really astonishing. The exemplary order and harmony which prevail among the different members of the family, and the economy and neatness manifested in its domestic regulation, are worthy of peculiar notice; and a great share of the present prosperity of the institution must be attributed to the conscientious and judicious discharge of their duties, by the Friends who reside at, and have the immediate superintendence of, the asylum.

The officers of the institution consist of twenty managers, a treasurer, and clerk, who are annually elected by the contributors. The managers appoint the superintendent and matron, the visiting and consulting physicians, and the officers and assistants employed in the service of the establishment: they are so classed that three of their number inspect the Asylum weekly, on Saturday, each visiting manager serving two months. Any monthly meeting belonging to the yearly meeting of Friends held in Philadelphia, contributing two hundred dollars, and every individual subscribing six dollars per annum, or twenty‐five dollars at one time, and being and continuing members of the Society of Friends, become members of the association.

No patients are admitted excepting those who are members of the Society of Friends, or professors of their doctrines. Many believe that it requires the actual right of membership to procure the privilege of admission; and others are so narrow‐minded as, if not to denounce, to withhold well‐merited praise from an institution, which, according to them, grew out of and is guided by sectional spirit. To the first, we answer, that fifteen of the thirty‐seven patients now in the house, do, not belong to the society; and the latter would do well to remember that, while Friends support their own poor, and prevent them from becoming a burden upon society, they contribute their full share to the maintenance of the poor of all other denominations. Not an individual, we believe, was found so bigotted [bigoted] as to attack the sectional spirit of Friends, when they relieved their fellow citizens from a portion of the poor‐rates by establishing the Friends' Alms House in Walnut street. Why then should they not be permitted, undisturbed, to watch over and nurse the insane, as well as the poor of their society? With equal propriety, might they be required to receive at their alms‐house, the paupers of other denominations, as grant the admission of lunatics at their asylum, not attached to the society, nor comprehended in the plan of the institution. It might, indeed prove serviceable to it, so long as there is vacant room to admit patients of other sects, under the stipulation that they should be removed to make room, at any time, for members of the society: but it should be done as a matter of favour, not of right. The lowest rate of board is two, the highest five dollars per week; the patients to make compensation for all damages done by them to the glass, bedding, or furniture,⁷ or to pay, in lieu thereof, a small addition to their board. At the present time, the patients amount to thirty‐seven, which is a greater number than at any former period; with four keepers, or about one to every nine. Every patient has a distinct bed and apartment; – neither double beds, nor the placing of more than one patient in a room being allowed. More than fifty patients could be thus comfortably accommodated.

The near relations or particular friends of patients are permitted to see their connexions when circumstances will admit; but in most cases, these visits are productive of more evil than good. Patients are frequently more unsettled and ungovernable for some time afterwards. The general admission of visiters would be improper and injurious: patients never ought to be exhibited to gratify the curiosity of strangers. No persons, therefore, are admitted to the apartments occupied by patients, unless accompanied by a manager; but on application to the superintendent, they may obtain permission to view the other parts of the building and the adjacent grounds.

The original cost of the building, was about $ 43,000, and of the farm $ 6760; since when $ 3000 have been expended in improvements and repairs on the former, and $ 850 on the latter. During the last five years, from 1820 to 1825, inclusive, the expenses of the institution, including general supplies, salaries, wages, furniture, medicines, books, and incidental expenses, (as taxes, printing, stationary, &c.) averaged $ 3762 per annum. In the same period, the average annual amount received for board of patients, including clothing and damages committed, was $ 4292. The amount of payment for board, clothing, articles destroyed, and other expenses of patients, for the year ending in March, 1824, were $ 4375 01; and for the next year, $ 4265 01: the family expenses, including supplies, salaries and wages, were in those years respectively, $ 3366 29 and $ 3111 53. The aggregate amount of legacies left to the institution, including that of James Wills, of $ 5000, is $ 10,826. The whole debt of the contributors, which, in 1818, amounted to $14,933, has been annually and gradually reduced, and amounted, in March, 1825, to $ 7933. The library, founded by a donation of 200 volumes, valued at $ 500, is small, but well‐selected, and consists principally of medical and religious works.

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Scripture Truths Demonstrated; being sermons or declarations, by William Dewsberry, Robert Barclay, William Penn, Richard Ashby, William Bingley, Charles Marshall, Samuel Waldenfield, John Butcher, John Bowater, Francis Camfield, George Whitehead, John Vaughton, Francis Stamper, Thomas Story, Samuel Scott, and Deborah Bell.

Memorials concerning several Ministers and others, deceased, of the religious Society of Friends, within the limits of the Yearly Meeting of New York, with some of their last experiences.

This new collection contains accounts of William Mott, Joseph Walters, David Howland, Sarah Clapp, Matthew Franklin, Phebe Upton, Hannah Hoag, Jesse Haviland, Phebe Meader, Elizabeth Jones, David Sands, Rufus Hall, James Hallock, John Murray, jr., Fry Willis, Naomi Halsted, Comfort Upton, Henry Chase, Silas Downing, Jacob Underhill, James Mott, Mary Comstock, and Mary Slocum.

A Letter to a Friend on the authority, purpose, and effects of Christianity, and especially on the Doctrine of Redemption, by Joseph John Gurney.

Kersey's Treatise of the Fundamental Doctrines of the Christian Religion.

Letters of the late John Thorp, of Manchester, a Minister of the Gospel in the Society of Friends; to which is prefixed, a Memoir of the Life of the Writer.

Memoirs and Letters of Richard and Elizabeth Shackleton, late of Ballitore, Ireland; compiled by their daughter Mary Leadbeater.

Christian Discipline, Public Religious Worship, and Gospel Ministry, briefly considered, by William Alexander.

Observations on the importance of Female Education and Maternal Instruction, with their beneficial influence on society, by Abigail Mott.

A Guide to True Peace, or a method of attaining to inward and spiritual prayer.

Barclay's Apology for the True Christian Divinity, as held by the People called Quakers.

Barclay's Catechism and Confession of Faith, which contains a true and faithful account of the Principles and Doctrines of the People called Quakers.

History of the People called Quakers, by William Sewel, 2 vols.

Portraiture of Quakerism, by Thomas Clarkson, 3 vols.

Life of William Penn, by Thomas Clarkson, 2 vols.

History of the Abolition of the Slave Trade, by Thomas Clarkson, 2 vols.

Murray's Compendium of Religious Faith and Practice.

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The Doctrines of Friends: or Principles of the Christian Religion, as held by the Society of Friends, commonly called Quakers. By Elisha Bates.

Observations on the Religious Peculiarities of the Society of Friends, by Joseph John Gurney.

An Introduction to the Critical Knowledge and Study of the Holy Scriptures, by Thomas Hartwell Horne. In 4 volumes.

[Historical Note]

This text is a description of the Friends Asylum by Robert Waln, Jr.. The author lived from 1794 to 1825, and came from a prominent Philadelphia Quaker family. He is best known for his writings and research on China. The text originally appeared in the Philadelphia Journal of the Medical and Physical Sciences, which later became the American Journal of Medical Sciences, and continues to be in publication.

The Friends Asylum was opened to patients in 1817. It was the first private hospital in the United States that was entirely dedicated to the treatment of mental illness. The Friends Asylum was based on the York Retreat, which was started in England in 1796. The core missions of these facilities were to care for members of the Society of Friends, and the Quaker belief system informed many of their practices.

The creation of the Friends Asylum was also significant because it was the first American psychiatric facility that was based on the moral treatment model, which emphasized the role of the environment on causing and curing mental illness. The asylum created a respectful and dignified environment for the patients, which, according to the model, would strengthen the rational portion of a patient’s mind. Eventually, the rational portion could control the insane portion, and the patient would be cured.

The Friends Asylum was renamed Friends Hospital in 1914. The hospital is still in operation, and continues to specialize in the treatment of mental and emotional illness. More information about Friends Hospital and the hospital’s history can be found on their website’s discussion of their Mission and History:http://www.friendshospitalonline.org/ceo.htm

[Bibliographic Information]

Author: Waln, Robert, 1794‐1825.

Title: An account of the asylum for the insane, established by the Society of Friends, near Frankford, in the vicinity of Philadelphia … from the Philadelphia journal of the medical and physical sciences, for August, 1825.

Publication information: Philadelphia : Benjamin & Thomas Kite ..., 1825.

Collation: 34, [2] p. ; 17 cm. (12mo)

General Notes: Verso of t.p.: "Skerrett ‐ Locust Street, Philadelphia."

With a final leaf of advertisements.

References: Sabin, 101133; Shoemaker, 23197

Subjects:

Asylum for the Relief of Persons Deprived of the Use of Their Reason.

Hospitals, Psychiatric

Pennsylvania

Call number: WX W217a 1825

Credit: Electronic text for Medicine in the Americas edited by Amanda Reyes, March, 2004.

When a detached wing of the York Lunatic Asylum, in England, was consumed by fire on the 28th December, 1813, four of the patients, (from these causes,) perished in the flames.

Spurzheim.

Bakewell.

Spurzheim.

Spurzheim.

Coal will be used in the ensuing winter.

It is a remarkable fact that, from the opening of the institution until the year 1824, a period of seven years, the whole amount of charges of this nature against all the patients was only $30 19 on account of glass broken, and $27 17, for damages done to furniture.

Footnotes

1

When a detached wing of the York Lunatic Asylum, in England, was consumed by fire on the 28th December, 1813, four of the patients, (from these causes,) perished in the flames.

2

Spurzheim.

3

Bakewell.

4

Spurzheim.

5

Spurzheim.

6

Coal will be used in the ensuing winter.

7

It is a remarkable fact that, from the opening of the institution until the year 1824, a period of seven years, the whole amount of charges of this nature against all the patients was only $30 19 on account of glass broken, and $27 17, for damages done to furniture.